National sociodemographic disparities in the treatment of high‐risk prostate cancer: Do academic cancer centers perform better than community cancer centers?

Mahal, Brandon A.; Chen, Yu-Wei; Muralidhar, Vinayak; Mahal, Amandeep R.; Choueiri, Toni K.; Hoffman, Karen E.; Hu, Jim C.; Sweeney, Christopher J.; Yu, James B.; Feng, Felix Y.; Kim, Simon P.; Beard, Clair J.; Martin, Neil E.; Trinh, Quoc Dien; Nguyen, Paul L.

doi:10.1002/cncr.30205

Cited by 27 publications

(26 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This investigation is one of the first to report stark differences in treatment uptake by race in a population‐based cohort of men with advanced prostate cancer including the most current treatment modalities for men diagnosed with metastatic disease. Our results are consistent and complement a number of investigations examining treatment disparities among men with both low‐risk prostate cancer and those with high‐risk, but organ‐confined disease …”

Section: Discussionsupporting

confidence: 88%

Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER‐Medicare investigation

et al. 2019

View full text Add to dashboard Cite

Purpose Approximately 5% of men were initially diagnosed with (also referred to as de novo) advanced stage prostate cancer and experience far poorer survival compared to men diagnosed with local or regionally advanced disease. Given the number of new therapies targeting metastatic and castrate‐resistant disease, we sought to describe recent treatment patterns by race for de novo AJCC stage IV prostate cancer. Methods We used Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare files to identify men aged 66 and older diagnosed in 2004‐2014 with advanced prostate cancer, and examined patterns of treatment among all patients and stratified by race/ethnicity. Results There were 8828 eligible patients identified, and non‐Hispanic black (NHB) patients were more likely to go without treatment (P < 0.001) compared to non‐Hispanic white (NHW) patients, even after accounting for early mortality and TNM stage. The frequency of nearly all forms of treatment was lower among NHB with the exception of orchiectomy, which was significantly higher (10.1% vs 6.1%, P < 0.001), and the use of the progesterone Megace among Medicare Part D enrollees (24.6% vs 15.0%, P < 0.001). Conclusions Results from this study of elderly Medicare patients presenting with advanced stage prostate cancer suggest that NHB men are less likely to pursue aggressive treatment options. With the reduction in screening for prostate cancer, presumably tied to USPSTF recommendations, and the increasing incidence of men diagnosed with de novo metastatic disease, understanding drivers of treatment‐related decisions are critical in reducing racial disparities in advanced prostate cancer outcomes.

show abstract

Section: Discussionsupporting

confidence: 88%

Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER‐Medicare investigation

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In 2014, life expectancy for blacks was 75.6 years compared to 79 years for whites. Despite numerous efforts over the past few decades, ethnic older adults continue to receive unequal treatment compared to their white counterparts across a broad variety of specialty care . A recent national study of interhospital transfers of 46 406 patients from a small‐ or medium‐sized hospital to a larger acute care hospital of mechanically ventilated patients with sepsis concluded that black and Hispanic older adults are less likely to be transferred.…”

Section: Health Disparities Are Persistent and Pervasivementioning

confidence: 99%

Building a Culturally Competent Workforce to Care for Diverse Older Adults: Scope of the Problem and Potential Solutions

Periyakoil

2019

J American Geriatrics Society

View full text Add to dashboard Cite

The population of minority older adults is going to explode over the next four decades. Older adults from racial and ethnic minorities face persistent and pervasive health disparities. Health disparities exert a huge fiscal burden on the nation. The national financial cost of health disparities for the years 2002 to 2006 was an estimated 1.23 trillion dollars. As the aging population becomes more diverse, these disparity-related costs are expected to increase. Older adults from racial and ethnic minorities face multiple barriers to accessing health and support services that will help them to age and die in place in the community. Patientrelated barriers include limited English proficiency, low health literacy, varying levels of acculturation, biases about Western healthcare and medications, mistrust of clinicians, inability to navigate the complex healthcare system, and cultural beliefs and taboos. Clinician-related barriers include ageism (ie, discrimination against older people due to negative and inaccurate stereotypes), conscious and unconscious bias, being deeply entrenched in the culture of biomedicine, and the lack of training in the principles and practice of providing culturally respectful care. Health system-related barriers include lack of culturally tailored services, including access to medical interpreters. We conclude by identifying three specific strategies to facilitate culturally humble and respectful care for diverse patients.

show abstract

“…Through further analysis, they also discovered that African Americans and Hispanic patients were more likely to experience significant delays before receiving treatment, and were less likely to receive definitive therapy, when compared with non-Hispanic whites, across both academic and community centers. 29 These findings demonstrate that while academic cancer centers did perform better than community cancer centers, academic centers may not be outperforming community cancer centers in treating patients among nonwhite, racial, and ethnic minority populations.…”

Section: Breast Cancer: Basic and Clinical Researchmentioning

confidence: 87%

Endocrine Therapy Plus Anti-HER2 Therapy as Adjuvant Systemic Therapy for Luminal HER2-Positive Breast Cancer: An Analysis of the National Cancer Database

Nahleh

Elimimian

Elson

et al. 2020

Breast Cancer�(Auckl)

View full text Add to dashboard Cite

Background: Guidelines regarding the usage of adjuvant systemic therapy in patients with small human epidermal growth factor receptor 2 (HER2)-positive and estrogen receptor/progesterone receptor–positive (luminal HER2 positive) tumors are nonspecific. Outcomes of chemotherapy followed by endocrine therapy (ET), with or without anti-HER2 therapy, vs ET alone (no chemotherapy) have not been widely studied in this disease subtype. We sought to examine the usage and outcomes of adjuvant systemic therapy (ET vs chemotherapy with or without trastuzumab) in stage I luminal HER2-positive breast cancer (BC), based on the large National Cancer Database. Methods: We conducted a retrospective analysis of patients with luminal HER2-positive stage I BC, diagnosed between 2010 and 2015, in the United States, using univariable and multivariable logistic regression analyses. The Kaplan-Meier method estimated overall survival (OS). Results: A total of 37 777 patients were included in the analysis; of these, n = 32 594 (86%) received adjuvant ET and n = 5183 (14%) received chemotherapy. Around 40% of all patients received anti-HER2 therapy (trastuzumab). Patients who received trastuzumab had a better 5-year OS (93.4% vs 92.0%, P = .0002) compared with those who did not. Patients who received anti-HER2 therapy plus ET had the best OS rate at 5 years (93.5%, confidence interval [CI]: 89.2%-98%, P < .0001) compared with those receiving anti-HER2 therapy plus chemotherapy (92.7%, CI: 89.4%-96.1%, P < .0001). Conclusions: Most patients in the United States, with stage I luminal HER2 positive BC, received ET, not chemotherapy but most of them do not receive anti-HER2 therapy resulting in inferior outcome. Future trials exploring the de-escalation of systemic adjuvant therapy for early-stage luminal HER2-positive BC to ET plus anti-HER2 therapy would be desirable.

show abstract

National sociodemographic disparities in the treatment of high‐risk prostate cancer: Do academic cancer centers perform better than community cancer centers?

Cited by 27 publications

References 14 publications

Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER‐Medicare investigation

Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER‐Medicare investigation

Building a Culturally Competent Workforce to Care for Diverse Older Adults: Scope of the Problem and Potential Solutions

Endocrine Therapy Plus Anti-HER2 Therapy as Adjuvant Systemic Therapy for Luminal HER2-Positive Breast Cancer: An Analysis of the National Cancer Database

Contact Info

Product

Resources

About